Pain Medicine Fellowship Curriculum

At Wake Forest School of Medicine, during the procedure/consult rotation, the fellows provide interventional and surgical pain medicine procedures, and also oversee the inpatient consult service. Ninety-­‐five percent of the procedures are performed under fluoroscopy or ultrasound guidance. A full variety of interventions are performed including:

  • Epidural procedures (e.g. cervical, thoracic, lumbar, sacral interlaminar and transforaminal epidural steroid injections)
  • Radiofrequency nerve destruction (e.g. radiofrequency ablation of medical branch nerves, genicular nerve ablation)
  • Radiofrequency bone tumor ablation 
  • Neuromodulation trial procedures (e.g. spinal cord stimulators)
  • Neuromodulation permanent implantation (e.g. peripheral nerve stimulators, spinal cord stimulator, IPG exchange)
  • Vertebral augmentation procedures (kyphoplasty, sacroplasty etc)
  • Peripheral Joint procedures (e.g. shoulder, hip, knee injection and denervation)
  • Spinal Stenosis decompression (e.g. interspinous spacer implantation)
  • Intrathecal procedures (e.g tunneled intrathecal catheter placement)
  • Intrathecal permanent procedures (e.g. intrathecal pump implantation)
  • Intradiscal procedures (e.g. discograms. biaculoplasty)
  • Sympathetic nerve/plexus procedures (e.g. stellate ganglion block, celiac plexus)
  • Peripheral nerve procedures (e.g. ilioinguinal, lateral femoral cutaneous nerve block)
  • Orofacial procedures (e.g. trigeminal nerve block)

Surgical implants are performed at all facilities. The surgical block time averages 10-­16 surgical procedures per month. Of note, neuromodulation and intrathecal drug delivery procedures comprise the majority of these cases, though there is also exposure to vertebroplasty and kyphoplasty techniques. Occipital nerve stimulators, as well as a variety of other peripheral nerve stimulators are implanted in addition to the over 200 permanent spinal cord stimulator implants performed per year. The case volume at Wake Forest Baptist Pain Medicine provides an outstanding interventional training for our fellows.

Fellows manage patients that suffer from a wide variety of painful conditions and pain syndromes including:

  • Spine (Axial and Radicular) Pain – Sacral, Lumbar, Thoracic, Cervical
  • Musculoskeletal Pain      
  • Neuropathic Pain
  • Cancer related Pain
  • Headache/Facial Pain

The attending physician provides fellow supervision, ensuring appropriate patient care and ongoing case-based learning.

Clinical Rotations

Pain Medicine fellows rotate through clinics at Wake Forest Baptist Health with primary responsibility for new patient evaluations and existing patient management.

Fellows also rotate through procedures at:

  • Wake Forest Pain and Spine Centers
    • Brookstown Pain Center
    • Lexington Pain Center
    • Clemmons Spine Center
    • High Point Pain Center

Outpatient procedures are performed daily by the fellows at these state-of-the-art facilities. Each fellow dedicates an average of one day per week to performing all of the blocks. Procedures are performed under either fluoroscopic or ultrasound guidance.

Fellows will also:

  • Oversee the inpatient consultation services
  • Perform operating room-based procedures
  • Perform office-based spinal cord stimulator trials

Chronic pain consultations are provided for inpatients at Wake Forest Baptist Medical Center. The fellows cover this rotation for one week at a time.

Fellows play an instrumental role in educating and overseeing junior and senior Anesthesiology residents in their pain medicine education when they rotate through the Wake Forest Pain Centers.

Multidisciplinary learning is further enhanced with rotations with:

  • Addiction Medicine
  • Inpatient Pain
  • Neurology
  • Physical Medicine and Rehabilitation
  • Radiology
  • Psychiatry

On Call Duties

Fellows are scheduled to take call on a rotational weekly basis, starting every Monday at 8:00 am.  The On-Call schedule includes nights and weekend coverage.  Fellows will cover a minimum of 1 holiday per academic year.  Fellows will rotate with our Inpatient Pain providers to gain experience with Inpatient chronic and acute pain, as well as Addiction Medicine prior to their first call week.  Fellows are actively involved in the organization of the outpatient clinics and will manage patient callbacks to help coordinate the surgical schedule.

Conferences and Didactics

Fellows participate in weekly didactic seminars from the teaching staff covering Accreditation Council for Graduate Medical Education (ACGME) pain topics as well as regular journal clubs and morbidity and mortality (M&M) conferences.

Research Opportunities

Clinical translational research and biomedical informatics is led by Dr. Robert Hurley, Dr. Amber Brooks, Dr. Meredith Adams and Dr. Heather Columbano and staffed by Wake Forest Pain and Anesthesiology faculty where research trials are performed.  Fellows are encouraged to participate.

Patients are also considered for ongoing research studies, as appropriate.